Provider Demographics
NPI:1134267545
Name:KREVAT, SETH (MD)
Entity type:Individual
Prefix:
First Name:SETH
Middle Name:
Last Name:KREVAT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5000 OVERLOOK RD NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20016-1912
Mailing Address - Country:US
Mailing Address - Phone:202-450-4562
Mailing Address - Fax:
Practice Address - Street 1:3800 RESERVOIR ROAD, NW 5 PHC
Practice Address - Street 2:MEDSTAR GEORGETOWN UNIV HOSPITAL - DEPT OF MEDICINE
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20007
Practice Address - Country:US
Practice Address - Phone:202-244-9869
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2014-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00042764207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8357188Medicaid
WAP00172793OtherRAILROAD MC#
WA5878KROtherBLUE SHIELD #
WA0039581OtherLABOR AND INDUSTRIES #
WAUS7459519OtherAETNA SPECIALIST PIN
WA0039581OtherLABOR AND INDUSTRIES #
WA8804661Medicare PIN